John Sotos, MD – Medical Historian and Abraham Lincoln Biographer

January 10, 2012

Abraham Lincoln in 1865 with arrows showing presence of lip neuromas

Where are you from?

Quite possibly I was once younger than 18. I have vague memories of going to public school. It is equally possible, however, that those memories were implanted by a giant computer Matrix during time I spent in an ooze-filled vat, before taking the red pill.

What did you major in in college and where did you go to school?

I went to Dartmouth and did two majors, mathematics and chemistry, but basically lived in the computer center. As it turns out, our computer actually was part of a giant Matrix. Medical school and all subsequent medical training was at Johns Hopkins, winding up as a transplantation cardiologist. Somewhere in there, a Stanford masters in computer science – artificial intelligence – got thrown in. More Matrix.

How did you come up with and develop the idea for zebra cards?

It was a combination of two things. In our introductory clinical skills course in the second year of medical school, I was fascinated to learn that pillows could be used to assess cardiac function — i.e. the routine cardiovascular history question about orthopnea. It was both counter-intuitive, because it had nothing to do with exercise, and very Sherlock Holmesian.

That same month I was rummaging in a dumpster outside the hospital – hey, in those days there wasn’t a lot to do in Baltimore – and found a metal file-box containing thousands of almost-blank index cards. So I started writing down on these cards all of the surprising clinical things I was learning about humans.

At some unremembered, point I started putting the observation on one side and the differential diagnosis on the other, and found it was kind of entertaining.

How did you conceive of the theory that Abraham Lincoln had MEN2?

It was almost random. Ever since hearing a lecture by Dr. Victor McKusick in medical school, I’d known that it was an open question whether Lincoln had Marfan syndrome. Dr. McKusick was one of my medical heroes, so I never forgot this.

Twenty-five years later I heard of a newly described Marfan-like disorder, called Loeys-Dietz syndrome, and six months after that read something in a random history book that suggested it might be Lincoln’s diagnosis. So I launched into research, but ultimately realized the answer was so embarrassingly and obviously “no,” that I resolved to never again think about Lincoln’s diagnosis.

Then, weirdly, several months after that, I happened to see medullary thyroid carcinoma (MTC) listed in a table in a random journal article, and got the immediate thought, “Lincoln,” for no apparent reason!

It took some deliberate thinking to figure out how MTC might relate to him. After a few minutes to educate myself about the spectrum
of lip appearance in MEN2B, which includes MTC as one of its cancers, and a few minutes to dip into the Lincoln material I’d already collected, I knew that MEN2B was a serious possibility in Lincoln.

Were you surprised that the work done by Dr. Eng did not corroborate your theory?

National Geographic did a fantastic job on the documentary. They showed the repeated difficulty we had getting DNA from the Lincoln artifacts available to us. The one thing I wish had been more clearly explained was how dubious it was that the DNA we finally got was actually human DNA from the artifact.

To get any DNA at all, we had to push the amplification techniques beyond prudent limits, and this was confirmed by the inconsistencies in the DNA yield, which strongly suggested the DNA was spurious. But we sequenced it anyway, rather like a Hail Mary pass, because we had nothing to lose: a positive result would have been diagnostic, and a negative result would have meant nothing.

So we looked for just one of the several single-nucleotide variants linked to MEN2B and didn’t find it. In my view, the result is a zero, not a negative.

What was the reaction of professional historians to theÂ fact that a non-classically trained historian orginated this theory?

I don’t have a lot of data on this. Two book reviews written by professional historians were very complimentary. Throughout my historical readings, I’ve rarely seen professional historians weighing in with personal opinions on technical medical subjects; they prefer instead to summarize the debate that physicians are having.

The non-professional history enthusiasts are entirely different. A loud minority are ready to offer dogmatic opinion without the slightest attempt to familiarize themselves with what they’re arguing against. It’s human nature, I suppose.

By the way, physicians can be of great help to professional historians by educating them on the possible consequences of a particular medical diagnosis in a historical figure.

Have you made any progress in getting in new samples to test?

I don’t talk about ongoing lab work. But, to any of your readers who have access to a Lincoln bio-artifact, please contact me.

Â Which piece of medical artifact of Lincoln’s do you think most strongly supports your theory?

The pictures and fates of Lincoln’s three youngest sons, out of four, is a huge part of the story. Before I started studying the pictures of Eddie, Willie, and Tad Lincoln — all of whom died before age 19 — I was fully prepared to admit that Abraham Lincoln might not have had MEN2B.

But the boys’ lips seal the deal. To my mind, the DNA test is superfluous. The photographs and histories of these four related individuals make the diagnosis. Lincoln’s mother had it, too, by the way.

What is one little known fact about Lincoln that you want the reading public to know?

Lincoln was not depressed. He only appeared to be — a phenomenon I like to call “pseudo-depression.” MEN2B caused this pseudo-depression.

Older journal articles emphasize that muscular hypotonia, or even frank myopathy, is a major feature of MEN2B. Although hypotonia is a very poorly appreciated syndrome in adults, there is no doubt it can mimic the physical features of depression.

Add to it a slumping posture and psychomotor retardation from hypotonia, and it’s easy to see how so many people thought he was depressed. The Physical Lincoln goes into much more detail.

What is next for you in getting your theory accepted?

I recently found a very compelling photograph that deserves to be published. And there is also the possibility of DNA.

Other than Lincoln, which President has the most arguable reason for close inspection of their medical history?

I’ll leave you with two. Medically speaking, the Presidency is all about the brain. Anyone with any interest in the Presidency knows about Woodrow Wilson’s catastrophic stroke, but Ronald Reagan’s dementia and William Taft’s man-eating sleep apnea — both of which occurred in office — carry important, and not yet fully explored, lessons for history and government.

Taft, for example, could not stay awake during daytime conversations… and so, when I read a highly respected historian’s lunatic claim that Taft’s presidency was not affected by this disease, I develop some despair for the future of our republic.

Comments

This is an impressive article, with some interesting ideas, but if mr. sotos further researches lincoln history he will find that there are preserved documents and quotes that speak quite plainly to mr. lincoln’s recurrent bouts of depression.

Could you look into the cause of death of Jacques Marquette, one of the first Europeans to see the Mississippi River, in 1673. He died of what the French called “the bloody flux” but there has never been a diagnosis regarding the origin of that problem.